Rectus sheath hematoma

Rectus sheath hematoma is an uncommon and often misdiagnosed condition resulting from either rupture of the epigastric vessels or the rectus muscle itself. The hematoma may be caused by coagulation disorders, trauma, or anticoagulation therapy [65]. Clinically, most patients present with acute... 

The acute clinical onset in a patient under anticoagulation supports the diagnosis of a rectus sheath hematoma. MR imaging may be useful in differentiation of chronic rectus sheath hematomas from anterior abdominal wall masses such as lipoma, hemangioma, neurofibroma, desmoid tumor, soft-tissue sarcoma, lymphoma, or metastatic lesions. Although bleeding into neoplasm may occur, hyperintense regions are rarely observed in tumors [66]. 

In the presence of a clinically suspected rectus sheath hematoma or equivocal findings in sonography, CT should be performed. CT usually allows the correct diagnosis and obviates unnecessary surgical interventions [67]. 

Fig. 17.20. Rectus sheath hematoma in CT. At the umhilical level, a spindle-shaped lesion is seen in the left rectus muscle (arrow). It shows homogenous high density and is surrounded at its anterior periphery by a minimal hypodense rim. Only minimal thickening of the adjacent lateral abdominal muscles can be noted...

Berni JD, Garcia-Medina V, Guirao J et al (1996) Rectus sheath hematoma diagnostic classification by CT. Abdom Imaging 21 62-64... 

A 45-year-old man with insulin-dependent diabetes associated with nephropathy, neuropathy, and retinopathy was given dextran 40 (25ml/hour) after orthopedic surgery (20). His urine output fell from 2 to 3 liters on postoperative day, 1 0 ml/day on day 2, and his creatinine clearance fell from 54 to 32ml/min-ute. There were many casts in the urine. Dextran was withdrawn, but his creatinine clearance fell to 12 ml/minute on day 5. On day 6 a large hematoma in the rectus sheath was drained, followed by plasmapheresis (to remove dextran) and hemodialysis. Over the next 24 hours, his urine output increased to 2.21/day... 

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